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TONTO
• Role model for clinical practice
• Role model for life long learning
• Assessment in the workplace
• Applicable to many settings
Components of the curriculum
Purpose wise judgements in uncertainty
Content
Teaching strategy role modelling
Assessment primacy of practice
Evaluation feedback built in
Curriculum design
• What educational purposes should we seek to attain?
• What educational experiences are likely to attain that purpose?
• How can these be organised effectively?• How can we determine whether these purpose are
being attained?
Tyler,R. 1949
What are we trying to assess ?
“Competence”
(shows he/she can do it)
“Performance”
(actually does it )
Competence Vs Performance
Is it reasonable to assume that competence is a good indicator of performance?
• Review of 18 studies assessing the relationship of competence and performance– Most use loose definitions
– Unable to support concept of a direct relationship
Rethans JJ, van Leeuwen Y, Drop R, van der Vleuten C, Sturmans F. Competence and performance: two different concepts in the assessment of quality of medical care. Family Practice 1990;7(3):168-74
Competence Vs Performance
• Study of GP’s– Standardised patients seen in normal surgeries
– Repeated in controlled practice environment
• Mean score for performance 49% lower than competency score
• Scores directly related to consultation time
Principles of assessment
• Valid - measures what it purports to measure
• Reliable - measures performance consistently
• Feasible - is practical, deliverable, affordable
• Educational - trainee learns from process
• Acceptable - those involved have confidence in it
Observed Clinical Practice
Hawthorne effect:
under observation, performance may differ
from normal behaviour
TONTO
• One to one teaching
• Role reversal
– Ensuring competence
– Demonstrating excellence
• Record of training
TONTO
direct observation of practice
working environment
real patients
uses structured recording sheets
measures performance
TONTO
• Trainer and trainee work together
• reduction in clinical service provided by the team
but
• some service is provided
• likely positive effect on efficiency overall
TONTO Training :
• One day course– Demonstration of process– Mainly hands on with SpRs– Some educational theory
Principles of assessment
• Valid - measures what it purports to measure assessor dependent• Reliable - measures performance consistently assessor dependent • Feasible - is practical, deliverable, affordable no sorting hat available• Educational - trainee learns from process assessor dependent• Acceptable - those involved have confidence in it initial experience positive